Choosing the Best Epilepsy Treatment for Your Dog: Conventional and Alternative Options

Is your dog struggling with epileptic seizures? Wondering about the best treatment options to help them live a full and happy life?

In this episode of the Call the Vet podcast, Dr. Alex breaks down everything you need to know about seizure treatments—from trusted medications like phenobarbitone and Pexion, to alternative therapies including medium-chain fatty acids, omega-3s, and CBD oil.

Discover which options may work best for your dog, learn about side effects, costs, and practical tips for managing epilepsy, and find out how most dogs with epilepsy can still enjoy a fantastic quality of life.

For more information check out the show notes: https://ourpetshealth.com/info/dog-seizure-treatment

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Transcript

[00:00:00] For dogs who have only had one or two, you know, very short seizures, maybe there's been a long timeframe between them. They might not otherwise be likely to benefit from starting traditional treatment. 'cause we don't start traditional treatment at the first. Short seizure. But these alternative options are great options to try 'cause they may help prevent your dog's situation from developing further.

Or they may delay the time needed before you then do need to start more conventional pharmaceuticals. They may even stop your dog's seizures. Completely welcome to the call the Vet Show, the podcast that helps pet parents understand and optimize the health of their furry family so they can live the full and happy life you want for them.

And here's your host veterinarian, Dr. Alex Avery. The right treatment of epileptic seizures in dogs can ensure they live a full and happy life. Getting this wrong, however has the [00:01:00] consequences that can be heartbreaking. I'm Dr. Alex. I've been a vet since 2006, and in this video I'm going to guide you through all of the main different treatment options for epilepsy in dogs, from our conventional pharmaceuticals to more recent additions and alternative.

Options you might not yet have considered. Now, each option has its own benefits, limitations, side effects, and success rates, which I'm going to review here. But it's also really important to know that your dog's seizure history, along with general body and organ health may also change which exact treatment option is best for your individual dog.

And so the first treatment I'm going to talk about is pheno, baritone, or phenobarbital. Now this drug comes in numerous different trade names, and it's probably the most commonly prescribed anti-seizure medication. It's been used to treat epilepsy in dogs for decades now. First things first, phenobarb is a first line treatment, so this means that reaching for this option before any other pharmaceutical is [00:02:00] completely appropriate.

This is because when used alone with no other anti-seizure medication, pheno. Baritone is it's effective in reducing seizure frequency. 60 to 93% of dogs when plasma concentrations are maintained within the therapeutic range, that means the amount of drug in the blood is at a range that we know should be working.

For those dogs where it is effective. Studies have shown that 85% of dogs can become seizure free for six months or longer. So that is a really successful outcome and the ideal outcome that we hope for every single epileptic dog is also one of the cheapest options available, which is always a bonus. But of course there are some important considerations here.

The first is that it can take a week or so to reach effective blood levels. In terms of side effects if they happen, they tend to be early after treatment started, or that dose has been increased before, then disappearing over the next few weeks. And these side effects include sedation and coordination, increased [00:03:00] appetite, increased drinking, and increased peeing.

More serious side effects are thankfully very rare. I've never seen them despite treating hundreds of epileptic dogs, but they can be serious and include liver toxicity and blood cell abnormalities to complicate things further, the body can also begin to break down this drug more quickly over time, and it's for this reason that monitoring, blood testing is recommended as well, of course, to ensure that there are no serious side effects developing, no matter how uncommon they are.

So these tests are looking at how healthy the body is, especially the liver, as well as ensuring the drug levels are where they need to be, so that the dose can then be adjusted as needed. Considering too, of course, how well those seizures have been controlled. If the blood tests show the levels are potentially a little bit lower than the ideal range, but a dog is seizure free, there's probably no real need to increase the dose, but just we can bear that in mind depending on how things go in the future.

So that's Vena baritone. The next [00:04:00] first line treatment in epilepsy in dogs is IEPI Toin. That's sold as the tray name is pian. Now this is a more recent drug, uh, and I remember when it first started to be used in 2013, so I'm kind of dating myself there. It has been shown to be just as effective as pheno baritone with the benefit being that there are generally fewer side effects.

Again, those are generally temporary and include increased appetite, which is probably the most common one. Empi Toin also kicks in a lot faster than phenobarbital, so you know what's not to love about that. Well, it's not unfortunately, a drug that is available in every country and where it is available.

Pian also tends to be significantly more expensive than pheno barone, and that is a cost which can really add up over the lifetime of your dog. So where do these two drugs sit in the pecking order? Well, you know, my take is that both pheno, baritone, and omeone, they're both really good starting treatments for the majority of epileptic dogs.

If cost is no [00:05:00] issue or if I feel that there is a real need for that treatment to be working as quickly as possible, then pion is generally what I reach for. For every other dog, it's likely to be pheno, baritone that I prescribe. So then the next most common anti-seizure medication, at least that I use is potassium bromide.

So there are a few big differences with this option compared to the others, which I've discussed. And the first is that this is not really a first line treatment. Nor is it a drug that should normally be relied on for use by itself, and this is because it's not nearly as effective as either the pheno, baritone, or the omeone at reducing seizure frequency.

The other difference is that it does take a long time to build up in the blood to reach those therapeutic levels that are needed to control seizures. In fact, it can actually take three months to reach a steady state within the blood. To get around this, we actually can start by giving a higher dose.

Although some dogs unfortunately won't tolerate that, they'll develop nausea [00:06:00] and vomiting, although giving it with food can help and so we can't do that loading dose, but either way, it takes a long time to start working. The other more common side effects, which should all be familiar by now, are sedation, wobbliness, and increased appetites, and again, they do tend to go away with time.

More serious issues. Thankfully are very rare, but they can include a change in personality with aggression or hyperactivity being concerned, and also an increased risk of pancreatitis, although again, that is a rare occurrence. Now, all of this means that on the surface, potassium bromine, it doesn't sound like a great option for treating epileptic dogs, but that is not true at all.

'cause where it comes into its own is as an additional. Treatment. So used in those dogs, which don't have a good level of control with either pheno, baritone, or omeone. So that's something that we can refer to as drug resistant epilepsy. So this drug is used in addition to those two first line treatment options [00:07:00] with pheno baritone, especially potassium bromide has what we call a synergistic effect.

So its addition can help to either eliminate or significantly reduce seizure frequency by over 50% in six outta 10 dogs who don't respond to pheno barone alone. So that might sound like not actually that many dogs, it's helping, but it's. It's over 50%. And remember, these are dogs with serious seizures that aren't responding to that first line treatment, so it is a really useful addition.

Now, the next pharmaceutical option is actually a drug whose name I really struggle with. It's a real tongue twister. I'll leave it here. We'll call it Keppra. That's the trade name. And again, this is typically an adjunct additional treatment used in drug resistant epilepsy. Although in some animals it may be that they are started off with Keppra as their initial first line treatment.

So similar to the bromide, the response rate to Keppra is reported to be in the region of about 57, 60%. So maybe not quite [00:08:00] as good as the Eex and Omeone or the pheno baritone. It is though a drug that is generally very well tolerated and it's got a really favorable safety profile. So mild side effects we can see against sedation ataxia.

So that's wobbliness. Decreased appetite and vomiting with more serious side effects, actually being very rare indeed. So this can be a great option for those where we're worried about side effects with those other drugs. Now, in terms of administration though, there are a couple of issues with Keppra and these are, that needs to be given three to four times a day, you know, and that's something that clearly won't be possible for every single dog owner.

The second issue with giving it is that some dogs will develop a tolerance to the drug over time. Something to be aware of if your dog is doing well on Keppra, but seizure control then kind of seems to be slipping. And then to round out the different pharmaceutical options, there are the much less commonly used options.

So if you're using these, then it's likely that you'll be working with a [00:09:00] neurologist. As it suggests, if you're on these, the tried and trusted options simply aren't working. So Zide is our first kinda more unusual anti-seizure medication. This is actually licensed for treatment of epilepsy in Japan. Good evidence seems to be lacking as to its true benefit or otherwise.

Care needs to be taken with regards to kidney and liver function, and it's not available in every country and where it is, it can be incredibly expensive. Gabapentin and the related pregabalin are used to treat epilepsy in people, but their benefit in dogs is questionable. With very few studies available and they consist of a handful of patients and they show unreliable results.

So where we tend to use these drugs are, are gabapentin or pregabalin can either be with trying to manage chronic pain, so often arthritis or some behavioral problems, but epilepsy, it, they don't really seem to have much of a role to play Two other options, which have also been looked at, uh, looked at in limited studies without convincing results.[00:10:00] 

Phal, Beate and Topiramate, and really these round out to our drugs used to treat epilepsy in dogs. Now, before I move on to the other options that can be used to help treat epilepsy in dogs, there are a couple of important things to consider with any drug treatment. So. These are generally lifelong treatments, and stopping them suddenly, or reducing their dose without guidance can actually trigger severe seizures, which may be life threatening.

So if you're going to make changes, make sure it's under the guidance of your vet. The next is that regular monitoring blood test is really important, not just to check the blood levels of the drugs in case of the pheno, baritone, or potassium bromide. But also to check General Body Health and ensure that we are not getting any serious side effects starting to occur.

This is even more important when several drugs are being given at the same time, or we have different conditions to epilepsy. Arthritis would be an example, and we're giving multiple different drugs. We really want to check that there's going to be no. [00:11:00] Drug interactions causing problems. And then dietary factors like salt content, diarrhea, vomiting, they can all affect drug absorption.

So keeping a diet constant and making any changes slowly and as well as addressing any intestinal upsets quickly. Are really important for epileptic dogs, and I know this can all feel like a lot to take in and, and every dog's situation really is unique and that's exactly why I built an interactive tool that gives you the guidance, personalized guidance for managing your dog's epilepsy.

It helps you feel confident in every decision, reduces the stress and uncertainty of the process, and ultimately gives your dog the best chance of living a happy full life despite their epilepsy. Because great news here, most owners of epileptic dogs feel that their dog has an excellent quality of life and they have a full and normal life expectancy.

So this tool is the next best thing to having a vet in your pocket guiding you step by step through each stages of their journey, kind of having conversations [00:12:00] back with you to allow you to work out what is best for you. Your dog. Now it is a premium resource, but if you want to learn more, then I've left a link down in the description below.

Okay, so we are moving on to alternative treatment options. Now, our non-pharmaceutical options, so some of these are newer, some have been around for a while and all have a certain degree of evidence, albeit potentially kind of very limited evidence at the moment to support their use in reducing seizure frequency and.

Severity. That being said, and a word of caution though, none of these options have been shown to be anywhere nearly as effective as our first line drug options. You also need to know that prompt effective treatment of epilepsy improves the likelihood of effective long-term control. So what that means is that if we are trying these alternatives instead of drugs and the epilepsy is getting worse and worse, we're going to compromise our ability.

If and when we then start drug treatment to successfully control [00:13:00] those seizures. So in my mind, this means a couple of things for dogs who have had any form of significant epileptic seizure in terms of frequency or duration. These alternatives are all options to add to conventional treatment with the aim to try and improve the chance of good control being achieved, potentially even seizure-free status being achieved.

It may also mean that we are able to have a lower dose and with reduced need for additional pharmaceuticals if we're using these options. Using these options alone without pharmaceuticals runs the risk of delaying that effective treatment, increasing the risk of serious seizures, and compromising the ability to achieve long-term control.

You know, that being said, for dogs who have only had one or two, you know, very short seizures, maybe there's been a long timeframe between them, they might not otherwise be likely to benefit from starting traditional treatment. 'cause we don't start traditional treatment at the first short seizure. But these.

Alternative options are great options to [00:14:00] try 'cause they may help prevent your dog situation from developing further, or they may delay the time needed before you then do need to start more conventional pharmaceuticals. They may even stop your dog seizures completely. And the other place that these alternative options have is if your dog experiences really severe side effects to traditional pharmaceutical options.

Something that I really have to stress is rare. But it's not zero. Um, you know, these alternatives are a great option to try in their place. And I'll also leave links to all of these options in the description to this video if you do want to check them out further along with that epilepsy tool that I spoke about.

So the first of these alternative seizure treatment options in dogs is medium chain fatty acids. So these are metabolized differently compared to our long chain fatty acids, and they lead to something. Called ketones being produced. So these ketones can then serve as an alternative fuel [00:15:00] for the brain.

They have the potential to stabilize neuronal activity, and so reduce seizures. Basically, they're feeding the brain in a different way that can kind of bypass the short circuitry that happens in epileptic seizures. So one small study looking at the impact of feeding a diet, which is Purina ProPlan, NC Neurocare.

Which contains 6.5% medium chain triglyceride oil. So dogs in this study, they had been treated for epilepsy for at least a year, and had to have experienced at least three seizures in the three months prior. So they'd been treated but they were still having seizures. The results of the study were that 10% of these dogs became seizure free, and 43% had a reduction of over 50% in seizure frequency.

So that is a really significant result, albeit in a small number of dogs. Another recent study of a small number of dogs, also with this drug resistant [00:16:00] epilepsy, showed that 18% of dogs that were given these medium chain fatty acids as an additional treatment had a greater than 50% reduction. Seizure frequency, 43% showed a seizure reduction of less than 50%, but 40% of dogs had no change or an actual increase in seizure frequencies.

So they certainly didn't benefit every single dog, but 60% of dogs who had this diet still a reduction in their seizure frequency. So these. Are small studies, um, that also run on epileptic dog whose seizures are poorly controlled with medication. So what we really want then to know is, and what we really want is further research with larger sample sample sizes, longer durations to confirm these results, and also to explore the effects in dogs with less drug resistant epilepsy.

What happens when we feed this diet to dogs who have epilepsy and have not received any medication or seem to be pretty well controlled [00:17:00] on something like pheno, baritone, or omeone. You know, really we need that information before we can recommend this as a starting option for our dogs. Now, practically, there are a few considerations here too.

These are the, there are only a small number of diets like the pro plan neurocare available that have been formulated to incorporate the levels. Of these medium chain fatty acids that's needed. An alternative is that these fatty acids, they can be added to the diet in the form of an oil supplement that contains high levels of caprylic and capric acid, so known as C eight and C 10 MCTs.

So this is not just plain coconut oil, but specially formulated supplements. So something like acrylic from Vet Plus. In terms of dose, we're talking about giving the amount of oil that provides 9% of the energy requirements of a dog. So depending on the product, of course, each meal is going to provide about seven to eight [00:18:00] calories.

So. We're talking about one and a half teaspoons of oil for every 10 kilograms or 22 pounds. Body weight, remember as well that any supplement or diet change needs to be carried out very slowly for dogs on any anti-seizure medication. And these supplements, they're not going to be appropriate for all dogs and really stress this because it's going, it's gonna depend on their history.

I definitely check in with your vet first. So a dog who's had pancreatitis in the past, you really would need to be very, very careful about adding oil to their diet. You're also going to need to reduce their normal diet by 10%, otherwise they're going to gain weight and become obese, and that is going to be a certainty.

Now, our next alternative option, it's another fatty acid, but we're talking about our Omega-3 fatty acids. So they, they may be beneficial to epileptic dogs, specifically our EPA and DHA, which are found in oily fish, krill, greenlit mussel, and other marine sources. So rather than our, um, rape [00:19:00] seeded linseed oils, for example, so our Omega-3 fatty acids, they have a natural anti-inflammatory effect.

We use them a lot for things like arthritis where they're fantastic. Really beneficial for allergic dogs as well. And. They're also believed to influence the lipid, so the fat composition of cell membranes, which affects the neurotransmitter function and ion channel activity within the nerve cells as well.

So evidence of benefit though for epileptic dogs is harder to find than with our medium chain fatty acid supplementation, but that is some evidence. Omega-3 fatty acids can reduce seizure activity in dogs, and even the feeding them to puppies may help protect against developing epilepsy later on in life.

So that's something to think about if there's a family history of epilepsy, because we know there is a genetic link, uh, genetic pathway for this disease. There's also some evidence to show that these supplements could help to reduce seizure frequency in epileptic children. So not [00:20:00] dogs, but. We are all mammals and we all work, you know, in fairly similar ways.

Now, I wouldn't supplement with both medium chain and Omega-3 fatty acids because the levels needed would mean that they would, they'd actually need to make cut. Too much of a diet's calories and there's going to be the potential to run into some quite serious issues potentially. Um, instead, what I would generally suggest reaching or when I would suggest reaching for our Omega-3 fatty acid supplements is in those dogs who don't tolerate are medium chain fatty acids, or where they've been tried without maybe any change in that seizure frequency or severity.

Also where there are other conditions where omega threes have a superior benefit. So if your dog does have any form of skin disease, if they have arthritis, um, or even if there's not a medium chain fatty acid supplement available to you because of where you are in the world, as for the dose. So a good place to start would be a hundred milligrams per kilogram of EPA and DHA combined.

So that would be [00:21:00] 450 milligrams for a 10 pound dog and 2,500 milligrams for a 25 kilogram dog. Again, though, build this up over a few weeks, reduce the amount of food that you're giving as well, and double check with your vet that there's no reason not to be starting these fatty acids. And then our next anti-seizure treatment alternative is CBD oil.

So CBD, you're gonna have heard about this. It's gained lots of attention over the past few years as a potential treatment for a really large number of different diseases. So in this case, we're looking at its potential anti-convulsant properties. So research has indicated that CBD can alter nerve activity as well as have an anti-inflammatory effect.

And it may be that this is actually contributing to its anti-seizure effects, but is this just hype or does the evidence back up the use of CBD? Well. One small 2022 study showed that about 43% of dogs showed a seizure reduction of greater than 50% when given [00:22:00] CBD at a dose of two milligrams per kilogram twice daily.

Another 2019 study. Showed a significant drop in seizure activity when dogs were given C, B, D. However, those given a placebo also had a similar number of dogs classed as treatment responders. So that's dogs through seizure frequency dropped by half. This is why we need bigger studies than a handful of dogs each.

Ultimately, I feel that there is some promise here, but possibly not quite to the degree that some would have you belief. And this is why for me, CBD oil is still very much an option to try in addition to those other more proven options rather than their replacement. But as always, further studies on larger numbers of non-drug resistant epileptic dogs will be great and help us to better understand where and how c, b, D and all of these other.

Can best be used. That's it for this episode of the Call the Vet Show. Be sure to visit, call the vet.org to join the conversation, [00:23:00] access the show notes, and discover our fantastic bonus content. We'll see you next time.